Evaluation of an eye drop guide to aid self-administration by patients experienced with topical use of glaucoma medication

BACKGROUND: Methods to improve patient compliance with prescribed topical use of glaucoma medication are sorely needed. A guide for the topical administration of ocular medication was suggested as such a tool. We investigated whether eye drop self-administration would be improved with use of the guide. METHODS: An eye drop guide, a funnel-shaped device designed to fit within the contour of the orbital margins, was offered to 114 patients for use at home with their glaucoma medication. A questionnaire asking about the ease of eye drop self-administration was administered before and after 1 week's use of the device. RESULTS: Of the 111 patients who accepted the guide, 93 returned a usable completed questionnaire. Seventy-four percent said that they found it easier to administer their eye drops without the guide and preferred to do so (chi2 = 21.77, p < 0.01). Patients using more doses per day found it more difficult to administer their drops using the guide (r = -0.233, p < 0.05), and those who had been using drops longer preferred not to continue using the guide (r = -0.222, p < 0.05). Patients who found the written instructions clearer found it easier to administer their drops using the guide (r = 0.329, p < 0.05). INTERPRETATION: Although intended to ease the administration of eye drops, the guide proved to be counterproductive. Further work is necessary to investigate other methods of improving patient compliance with prescribed topical use of ocular medications.     

Failure of Listeria monocytogenes keratitis to respond to topical ofloxacin

PURPOSE: The purpose of this case report is to demonstrate the need for identification of the offending pathogen in bacterial keratitis to guide appropriate treatment. METHODS: Case report. RESULTS: We report a case of Listeria monocytogenes keratitis in a young healthy adult that failed to respond to standard empirical therapy for bacterial keratitis but was treated successfully with topical ampicillin, chloramphenicol, and systemic amoxicillin. CONCLUSION: This case demonstrates the need for identification of the offending pathogen to guide appropriate treatment. It also demonstrates discrepancy between in vitro sensitivity and clinical response.     

Preferred walking speed for assessment of mobility performance: sighted guide versus non‐sighted guide techniques

Background: If visually impaired people had their sight fully restored, it is assumed that they would walk at their optimal speeds. Previous mobility studies have used preferred walking speed (PWS) to measure walking efficiency of visually impaired adults. Therefore, the actual speeds that visually impaired people adopt on a route can be expressed as a percentage of their preferred walking speed (PPWS). There have been two approaches used in previous studies for determining preferred walking speed.

• 1 the sighted guide technique (SG), which requires a subject to walk with a sighted guide and regard the latter as a perfect mobility aid, with the subject setting the preferred (optimal) walking pace.
• 2 the non‐sighted guide technique (NonSG), which requires a subject to walk alone along an unobstructed straight path for a certain distance, adopting the preferred (optimal) walking speed.

There is some debate on which technique is the better. This study was conducted to determine if there is any difference between the two techniques for determining visually impaired subjects' preferred walking speeds. Methods: Fourteen visually impaired adult subjects were recruited. PWS was determined by recording the time taken for a subject to walk an unobstructed, straight 20‐metre corridor path using each technique. Results: There was no significant difference in PWS using the sighted guide and non‐guided techniques. Conclusions: Either the SG or NonSG techniques can be used to determine PWS for a heterogeneous group of visually impaired subjects.     

眼眶神经源性肿瘤24例的临床分析

目的：分析眼眶神经源性肿瘤的临床特征及影像学检查的特点,指导临床诊断及治疗。

方法：收集临床病例,回顾性分析四种常见眼眶神经源性肿瘤的影像学特点及临床表现特征。

结果：眼眶神经源性肿瘤在临床表现及影像学特征方面各有特点。

结论：通过分析眼眶神经源性肿瘤的临床表现特点及影像学特征,可以指导此类疾病的临床诊疗。     

Illuminated artificial orbit for the training of vitreoretinal surgery in vitro

PURPOSE: Demonstrations and practical experiments are important constituents of the teaching of surgical principles and techniques to residents in ophthalmology. The objective was to develop an eye-support device for experimental and didactic use during vitreoretinal microsurgery in vitro. METHODS: Various eye-support devices with different light sources and illumination intensities were designed and tested. The main components of the final prototype are a high-intensity halogen lamp, a flexible light guide, a cylinder with a mirror inside, and a replaceable, transparent eye support with a ring-adapter. Light from the point source is reflected via the light guide into the cylinder and through the eye support transsclerally into the eye. RESULTS: The device illuminates the retina and the vitreous body sufficiently. It accentuates the transparent appearance of the retina and makes the three-dimensional structure more visible, for example, in case of retinal detachment. Subretinal tissue can be visualized and differentiated more precisely. CONCLUSIONS: The device is useful, in the teaching of residents and in experimental vitreoretinal surgery.     

Ophthalmic and visual profile of guide dog owners in Scotland

BACKGROUND/AIMS: Out of an estimated 90,000 visually impaired people in Scotland, 509 make use of a guide dog. Initial research in Northern Ireland suggests that the ophthalmic profile of guide dog owners (GDOs) is highly specific. The aim of this study was to compare the ophthalmic and visual characteristics of Scottish GDOs with other groups of visually impaired people. METHODS: A random sample of GDOs from central and northern Scotland (n = 82) underwent a detailed assessment of residual vision (distance and near acuity, visual fields, contrast, and glare sensitivity). Comparative data were obtained from two populations of visually impaired non-GDOs-one group attending hospital ophthalmic and low vision clinics (n = 50) the other social services rehabilitation clients (n = 35). All participants completed a questionnaire to elicit ophthalmic history, age, and registration details. RESULTS: GDOs were found to be significantly younger and more profoundly visually impaired than non-GDOs. The main causes of visual impairment were retinitis pigmentosa (23%), optic atrophy (15%), and retinopathy of prematurity (7%). Ninety nine per cent of GDOs were registered blind and had been visually impaired for an average of 39 years. Only 31% were totally blind. CONCLUSION: GDOs represent a unique minority of the visually impaired population. Epidemiological registration trends would suggest that the numbers of young profoundly visually impaired people are unlikely to increase relative to their elderly counterparts. This has implications on the future demand for guide dog ownership.     

BOOK REVIEWS

Book reviewed in this article: Basic refraction techniques: DD Michaels The Year Book of Neurology and Neurosurgery: RN Dejong, RD Currier and TM Crowell (eds) Vision enhancement training: AL Shankman Clinical Light Damage to the Eye: D Miller Dictionary of Visual Science. 4th Ed.: D Cline, HW Hofstetter and JR Griffin (eds) Ophthalmic technology: A guide for the eye care assistant: Stephen J Rhode and Stephen P Ginsberg (eds)     

Measurements of preferred walking speed in subjects with central and peripheral vision loss

BACKGROUND: Previous mobility studies have used Preferred Walking Speed (PWS) in order to determine the walking efficiency in terms of the Percent Preferred Walking Speed (PPWS) of visually impaired adults. PWS has been measured in previous studies using the sighted guide (SG) and non-sighted guide (NSG) techniques. This study compared the NSG, SG and string (ST) (subjects walked by holding on lightly to a cardboard tube attached to a piece of string) techniques of measuring PWS in visually impaired subjects. METHODS: Forty visually impaired subjects with central and peripheral vision loss were recruited. PWS was measured using the NSG, SG and ST techniques. For each technique, PWS was determined by recording the time taken for a subject to walk an unobstructed, straight 20-m corridor. RESULTS: There were no significant differences in PWS using the SG, NSG and ST techniques. CONCLUSION: For assessing walking efficiency, either the SG, NSG or ST technique could be employed when measuring PWS in visually impaired subjects.     

Pentacam眼前节检查的护理配合

目的:更好地配合医生完成Pentacam眼前节检查。方法:对280例临床患者进行了Pentacam眼前节检查,检查前了解受检者眼的状态,指导受检者的坐姿,安全散瞳,进行受检眼的固视及瞬目指导,在实际工作中总结该项检查中的护理配合要点和注意事项。结果:在检查前了解检查的目的,受检眼的状态,受检者的坐姿,安全散瞳,重视受检眼的固视及瞬目指导,取得了患者的良好配合,有利于护士顺利配合医生完成该项检查。结论:护士的精确指导和患者的良好配合是Pentacam检查顺利进行的重要保障。     

Development of an orbital endoscope for use with the free electron laser

PURPOSE: To explore the feasibility of designing, constructing, and testing an orbital endoscope for use with the free electron laser (FEL). METHODS: An experimental study with an author-designed laser delivery system through an endoscope was conducted. Two adult pig cadavers and 6 fresh human cadavers had orbital endoscopy performed to develop a method of optic nerve sheath fenestration (ONSF) with the FEL. Twelve orbits were used to develop the surgical procedure by comparing visualization media and surgical technique. In the first 7 trials, a different variable was changed; the procedure was then refined in the human cadaver experiments. An ONSF was performed with the FEL (6.45 microm, 30 Hz, 2 to 3 mJ, 250-microm spot size) through a glass hollow wave guide introduced through an endoscope in 4 human cadaver orbits. RESULTS: Visualization of the orbital structures was clearest with carbon dioxide; sodium hyaluronate did not displace the fat, and saline hydrated the orbital fat. Biopsy forceps alone did not produce a dural window in the four trials that used the forceps. A dural window was made by using the FEL through a glass hollow wave guide adapted to the Olympus HYF-XP endoscope in the second, third, fifth, and sixth human trials with the FEL. Histologic evidence of the ONSF was produced. CONCLUSIONS: A hollow wave guide capable of transmitting the FEL through an endoscope was successfully constructed. ONSF with the FEL applied through an endoscope is technically feasible. Additional studies are currently examining techniques to improve intraorbital endoscopy.     

Dilatation and stenting for naso-lacrimal duct obstruction: a pilot project.

PURPOSE: Obstruction of the naso-lacrimal duct has traditionally been treated by dacryocystorhinostomy. This pilot project aimed to evaluate the use of stents as an alternative approach to the treatment of naso-lacrimal duct obstruction. METHODS: Six patients with naso-lacrimal duct obstruction underwent a pre-procedural dacryocystogram to confirm the site of obstruction. Under local anaesthesia, they subsequently underwent dilatation of the naso-lacrimal duct using a guide wire and a plastic dilator aided by fluoroscopy and digital subtraction imaging. The stent was then placed with its head in the lacrimal sac and tail protruding out of the naso-lacrimal duct into the inferior meatus. Dacryocystography was repeated to confirm patency. Patients were followed up for a minimum of 12 months. RESULTS: The procedure was successfully completed in four of the six patients. In one patient, we failed to negotiate the guide wire and in one, a false passage was created. All four successful cases were rendered asymptomatic and their lacrimal passages remained patent at 12 months. CONCLUSION: Naso-lacrimal duct dilatation and stenting is a viable alternative to conventional dacryocystorhinostomy in the treatment of naso-lacrimal duct obstruction and merits a larger trial.     

Accuracy between clinical and radiological diagnoses compared to surgical orbital biopsies

AIM: To assess the concordance between diagnosing orbital lesions by clinical examination, orbital imaging, and histological evaluation, in order to help guide future research and clinical practice. METHODS: A retrospective analysis was undertaken at a large regional tertiary referral centre of all surgical orbital biopsies performed over a 5-year period, from 1st January 2015 until 31st December 2019. Accuracy and concordance between clinical, radiological and histological diagnoses are reported as percentage sensitivity and positive predictive value. RESULTS: A total of 128 operations involving 111 patients were identified. Overall, sensitivities of 47.7% for clinical and 37.3% for radiological diagnoses were found when compared to the histological gold standard. Vascular lesions that have characteristic clinical and radiological features had the highest sensitivity at 71.4% and 57.1%, respectively. Inflammatory conditions showed the lowest sensitivity in both clinical (30.3%) and radiological (18.2%) diagnoses. The PPV for inflammatory conditions were 47.6% for clinical and 30.0% for radiological diagnoses. CONCLUSION: Accurate diagnoses are difficult to reach by relying on clinical examination and imaging alone. Surgical orbital biopsy with histological diagnosis should remain the gold standard approach for definitively identifying orbital lesions. Although larger scale prospective studies would help further refine concordance and guide future research avenues.     

Book Reviews

Book reviewed in this article:
Clinical Ophthalmology A self-assessment guide , P Watts
MCQs in Ophthalmology AJ Vivian     

When your eyes have a wet nose: the evolution of the use of guide dogs and establishing the seeing eye

Formation of "The Seeing Eye," a school for guide dogs, has played a vital role in fostering efforts to develop guide dog programs in the United States and throughout the world. This brief review is intended to highlight the historical evolution of guide dogs for the blind and to tell the story of The Seeing Eye.     

Shooting a film photo slit lamp into the digital age.

PURPOSE: The purpose of this study is to describe a method of taking a slit lamp initially designed for film photography and updating it to provide digital photographs. METHODS: A "how-to" guide is provided. RESULTS: Updating a Nikon FS-2 slit lamp is more economic than many practitioners may realize. By using what is already available on the market, a few steps can make a would-be dated instrument useful for many years to come. CONCLUSIONS: The upgrade to the Nikon FS-2 slit lamp is not only possible, but is able to functional well in the clinical setting and capture high-resolution photographs.     

BOOK REVIEWS

Book reviewed in this article: Self-direction for lifelong learning:a comprehensive guide to theory and practice Philip C Candy Laser surgery in ophthalmology -practical applications Editors:TA Weingeist and SR Sneed Hypertension. Pathophysiology, diagnosis and management, Editors:Laragh Brenner New York:Raven Press, 1990 RRP 465.75 Psychology in vision care, RH Shute The art and practice of low vision, PB Freeman PB and RT Jose     

Post traumatic polymicrobial endophthalmitis,including Neisseria subflava

DESIGN: To report the second known case of post-traumatic endophthalmitis caused by Neisseria subflava. DESIGN: Interventional case report. METHODS: A two-year-old child with post-traumatic corneal laceration and uveal prolapse required medical and surgical therapy for endophthalmitis caused by multiple organisms including N. subflava. RESULTS: After aggressive therapy, patient had a favorable outcome without vision compromise. CONCLUSIONS: As there is still not a standard protocol for therapy for post-traumatic endopthalmitis, we recommend the use of broad-spectrum antibiotics via intravitreal, intravenous, and topical routes. Consideration of typical and unusual bacteria that have been reported to cause endopthalmitis, as well as the source of injury, should guide antibiotic choice.     

A guide to the evaluation of fourth cranial nerve palsies

PURPOSE To devise a cost-effective guide for the evaluation of fourth nerve palsies (FNP). METHODS A review of the pertinent English language literature was performed to devise a guide for the evaluation (including neuroimaging) of FNP. The authors report a retrospective review of imaging studies performed on 206 patients with FNP. RESULTS The literature was used to develop the imaging guide. In the retrospective chart review of 206 patients from two tertiary care centers, 28 patients (13.6%) underwent a computed tomography scan and/or a magnetic resonance scan. Of these patients, five had associated neurological symptoms (non-isolated), one was traumatic, five were congenital, four were vasculopathic, eleven were non-vasculopathic, and two were progressive. Following the recommendations of the imaging guide, the five isolated congenital FNP and the four isolated vasculopathic FNP would not have undergone neuroimaging studies. The total costs of these neuroimaging studies in these nine patients were 19,000 dollars. Four patients in the retrospective review with associated neurological deficits (non-isolated) should have undergone neuroimaging according to the guide, but did not. CONCLUSIONS Although the evaluation of FNP can be difficult, the decision to order neuroimaging can be improved by using an imaging guide. An imaging guide for the evaluation of FNP may allow more appropriate and cost-effective imaging of these patients. Isolated congenital, old traumatic, or vasculopathic FNP do not require neuroimaging studies. Patients with non-isolated FNP should have directed neuroimaging studies based upon the results of clinical examination.     

A guide to the evaluation of fourth cranial nerve palsies

PURPOSE To devise a cost-effective guide for the evaluation of fourth nerve palsies (FNP). METHODS A review of the pertinent English language literature was performed to devise a guide for the evaluation (including neuroimaging) of FNP. The authors report a retrospective review of imaging studies performed on 206 patients with FNP. RESULTS The literature was used to develop the imaging guide. In the retrospective chart review of 206 patients from two tertiary care centers, 28 patients (13.6%) underwent a computed tomography scan and/or a magnetic resonance scan. Of these patients, five had associated neurological symptoms (non-isolated), one was traumatic, five were congenital, four were vasculopathic, eleven were non-vasculopathic, and two were progressive. Following the recommendations of the imaging guide, the five isolated congenital FNP and the four isolated vasculopathic FNP would not have undergone neuroimaging studies. The total costs of these neuroimaging studies in these nine patients were 19,000 dollars. Four patients in the retrospective review with associated neurological deficits (non-isolated) should have undergone neuroimaging according to the guide, but did not. CONCLUSIONS Although the evaluation of FNP can be difficult, the decision to order neuroimaging can be improved by using an imaging guide. An imaging guide for the evaluation of FNP may allow more appropriate and cost-effective imaging of these patients. Isolated congenital, old traumatic, or vasculopathic FNP do not require neuroimaging studies. Patients with non-isolated FNP should have directed neuroimaging studies based upon the results of clinical examination.